| As I discuss career options with a group
| |
| | self-effacement? Do psychiatrists have
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| of third year medical students, I imagine
| |
| | so great a level of job satisfaction that
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| a marketing brochure for psychiatry
| |
| | they don't worry about money? I wonder
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| residencies in a world of mental health
| |
| | if the difference reflects a much larger
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| parity:
| |
| | problem-- that psychiatrists have bought
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| The brain is undeniably the most complex
| |
| | into a societal impression that mental
|
| organ of the human body. Treatments for
| |
| | health is less valuable than physical
|
| diseases of the mind and brain require
| |
| | health.
|
| the intricate understanding of chemistry,
| |
| | Support for this last concern can be
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| physiology, and anatomy common to all
| |
| | found when one looks at the funding of
|
| branches of medicine, as well as the
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| | mental health services in general, and
|
| ability to step outside of oneself to
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| | the tacit acceptance of the funding
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| objectively observe personality and
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| | situation by psychiatrists and other
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| emotion. The psychiatrist must tolerate
| |
| | mental health caregivers. My insurer is
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| the unsettling awareness of the
| |
| | required by statute to provide coverage
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| mysterious relationship between mind and
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| | for mental health services up to about
|
| matter, and must help others find their
| |
| | $2000 per year. On the other hand, there
|
| own answers to the mysteries of the human
| |
| | is no limit on payment for orthopedic
|
| condition. No wonder that the masters of
| |
| | injuries. The insured alcoholic is
|
| medicine-those who work in the vast field
| |
| | covered for the $1800 surgeon's fee for a
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| of interventional psychiatry-are so
| |
| | fractured kneecap- and more for the
|
| valued by society.
| |
| | incidental hospital bill and the bills
|
| The time has come for my transition from
| |
| | for physical therapy. If the alcoholic
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| psychiatric residency to psychiatric
| |
| | strikes his head, the radiologist
|
| practice. The prospect of six-figure
| |
| | receives $1200 to look at the MRI. And
|
| incomes suggests reward, at last, for
| |
| | if he abruptly stops drinking for a week,
|
| years of work and debt. For the
| |
| | the hospital is paid tens of thousands of
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| employers, under the guarantee of income
| |
| | dollars to help him through withdrawal--
|
| and benefits lies the expectation of
| |
| | only to turn him out to drink again. Yet
|
| productivity. This productivity is not
| |
| | to treat the primary alcoholism, the
|
| measured by patient satisfaction, symptom
| |
| | insurer will pay$2000. And if the
|
| improvement, or reduced morbidity.
| |
| | patient has spent $2000 for treatment of
|
| Rather the name of the game is the RVU,
| |
| | depression earlier in the year, the
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| and the way to get more RVUs is to see
| |
| | insurer will continue to pay for kneecap
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| more patients in whatever time is
| |
| | fractures and MRIs, but not for treatment
|
| available. I am grateful for the
| |
| | of the underlying cause of these
|
| opportunity to earn good money in the
| |
| | injuries-alcoholism. And other
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| service of a challenging and rewarding
| |
| | comparisons are equally dramatic. My
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| career. But I am also aware of the
| |
| | insurer will pay $70,000 or more for
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| striking difference between the salaries
| |
| | cardiac bypass to reduce a person's risk
|
| of psychiatrists and the salaries of many
| |
| | of a heart attack, but only $2000 per
|
| other physicians. As a former
| |
| | year for treatment of the same person's
|
| practitioner of one of medicine's more
| |
| | depression, to reduce risk of suicide.
|
| lucrative specialties, I find myself
| |
| | The narcotic addict is allowed $2000 for
|
| comparing my apparent value now with my
| |
| | treatment of heroin addiction, vs.
|
| value then. Why is my work now worth
| |
| | hundreds of thousands of dollars for a
|
| less than half as much as my work as an
| |
| | secondary HIV infection.
|
| anesthesiologist?
| |
| | The relatively low payments received by
|
| At the end of a night in the crisis
| |
| | psychiatrists can be blamed to some
|
| service last week I walked past a group
| |
| | extent on psychiatrists themselves. They
|
| of patients huddled in the cold, waiting
| |
| | accept their own devaluation when they
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| for the doors of the walk-in clinic to
| |
| | sign for lower salaries or when they
|
| open. As I looked at their tired faces,
| |
| | accept limitations on their ability to
|
| I realized the desperation they must feel
| |
| | practice psychotherapy. They allow
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| to leave homes or homeless shelters at
| |
| | administrators and others without medical
|
| such a cold and early hour, and make the
| |
| | training to dictate treatment plans. I
|
| trek to the clinic by foot or by bus.
| |
| | am reminded of the late 1980's when
|
| Their pains were certainly as great as
| |
| | anesthesia was becoming perceived as a
|
| the pains of any of my patients
| |
| | technical trade, and was challenged by
|
| presenting for surgery. But for some
| |
| | the expanding statutory roles of nurse
|
| reason there is less outrage over their
| |
| | anesthetists. Rather than narrowing
|
| lack of care than would be the case for a
| |
| | anesthesiology, the answer to devaluation
|
| group of patients with untreated
| |
| | was found by moving into critical care
|
| diabetes, appendicitis, or heart disease
| |
| | and pain medicine and asserting the roles
|
| standing outside a hospital. I realized
| |
| | of anesthesiologists as physicians.
|
| that like many in society, I had
| |
| | Similarly, cardiologists did themselves
|
| unwittingly accepted the scene before me
| |
| | and their patients well when they laid
|
| as adequate care for the mentally ill.
| |
| | claim to angioplasty, and called
|
| The RBRVS, or resource-based relative
| |
| | themselves interventional'. The new
|
| value scale, was instituted by Medicare
| |
| | technology brought public respect and
|
| in 1992 in an attempt to standardize
| |
| | money, which then yielded an explosion of
|
| payments for physician services.
| |
| | new treatments. I don't know what the
|
| Relative value units, or RVU's, are
| |
| | parallel path for psychiatrists will be,
|
| assigned to physician services based on
| |
| | but it is vital that as insights develop
|
| three main factors: physician work,
| |
| | into brain function, psychiatrists lay
|
| practice expenses, and the cost of
| |
| | claim to them, grasp them, and never let
|
| liability insurance. Physician work is
| |
| | them go. There is nothing like a brain
|
| determined by several factors including
| |
| | procedure to grab society's interest and
|
| time required for the service, the
| |
| | respect. In fact, I posit that the
|
| technical skill and physical effort, the
| |
| | simple adoption of the term
|
| mental effort and judgment, and the
| |
| | Interventional Psychiatry' would increase
|
| amount of stress experienced by the
| |
| | the funding of psychiatrists and
|
| physician due to the risk to the patient.
| |
| | psychiatric research by 20%.
|
| To arrive at the fair value' of
| |
| | The low priority of mental health
|
| services, the number of relative value
| |
| | services to society is, of course, a
|
| units is multiplied by a universal dollar
| |
| | complex issue. Stigma, lack of lobbying
|
| value, and adjusted slightly for practice
| |
| | resources, and denial of the impact of
|
| location according to regional cost of
| |
| | mental illness certainly play roles in
|
| living indices.
| |
| | the lack of public interest and
|
| In theory, this approach to payment
| |
| | investment in mental health. Resources
|
| provides a level playing field for
| |
| | are thin for the unemployed and uninsured
|
| physicians. Payments for a
| |
| | mentally ill, and the field of psychiatry
|
| cholecystectomy, for example, reflect the
| |
| | deserves kudos for attempting to meet the
|
| fortitude one must have to cut into
| |
| | needs of this population in return for
|
| someone's body and the time required for
| |
| | little financial gain. But for patients
|
| surgery and postoperative care. Medicare
| |
| | with resources, we must recognize and
|
| strictly adheres to this formula, but in
| |
| | advocate that mental health care is as
|
| the world of private insurance some
| |
| | important as treatment for a torn ACL,
|
| physicians' relative value units are more
| |
| | and deserves equitable reimbursement.
|
| valuable than others. In my region, for
| |
| | The abilities to laugh, to work, and to
|
| example, Medicare has decided that the
| |
| | love are as vital as the ability to
|
| relative value of a unit of physician
| |
| | return to beach volleyball.
|
| work is about $38. The largest
| |
| | Psychiatrists must realize that at some
|
| third-party payer in the area will pay
| |
| | point, expectations of relatively low
|
| psychiatrists, pediatricians, or family
| |
| | reimbursements and medical standing
|
| physicians about $50 per value unit. But
| |
| | become self-fulfilling prophecies, as our
|
| orthopedists and radiologists, or
| |
| | society tends to value those most who
|
| podiatrists providing orthopedic
| |
| | value themselves. The correction of
|
| services, are paid $100 per value unit.
| |
| | societal bias and the resultant
|
| What accounts for the difference in
| |
| | devaluation of our services will require
|
| payment? If not due to stress, physical
| |
| | constant efforts to educate, negotiate,
|
| or mental effort, risk, technical
| |
| | and assert the value of mental health
|
| proficiency, or practice cost, where does
| |
| | care in a healthy society. And
|
| the difference come from? Certainly not
| |
| | psychiatrists, as the voices, faces, and
|
| from supply and demand, as in my area it
| |
| | business representatives of mental
|
| is much easier to see an orthopedist this
| |
| | health, will raise the status and
|
| week than to see a psychiatrist within
| |
| | treatment of their patients as they work
|
| the next month. Does the lower
| |
| | to raise the scientific, and yes,
|
| reimbursement reflect decades of poor
| |
| | economic, status of themselves as
|
| negotiating? Are psychiatrists more
| |
| | physicians.
|
| likely to succumb to modesty and
| |
| |
|
